Journal ArticleDOI
Normalization of Hemoglobin Level in Patients with Chronic Kidney Disease and Anemia
Tilman B. Drüeke,Francesco Locatelli,Naomi Clyne,Kai-Uwe Eckardt,Iain C. Macdougall,Dimitrios Tsakiris,Hans-Ulrich Burger,Armin Scherhag +7 more
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TLDR
In patients with chronic kidney disease, early complete correction of anemia does not reduce the risk of cardiovascular events and there was no significant difference in the combined incidence of adverse events between the two groups.Abstract:
BACKGROUND Whether correction of anemia in patients with stage 3 or 4 chronic kidney disease improves cardiovascular outcomes is not established. METHODS We randomly assigned 603 patients with an estimated glomerular filtration rate (GFR) of 15.0 to 35.0 ml per minute per 1.73 m 2 of body-surface area and mild-to-moderate anemia (hemoglobin level, 11.0 to 12.5 g per deciliter) to a target hemoglobin value in the normal range (13.0 to 15.0 g per deciliter, group 1) or the subnormal range (10.5 to 11.5 g per deciliter, group 2). Subcutaneous erythropoietin (epoetin beta) was initiated at randomization (group 1) or only after the hemoglobin level fell below 10.5 g per deciliter (group 2). The primary end point was a composite of eight cardiovascular events; secondary end points included left ventricular mass index, quality-of-life scores, and the progression of chronic kidney disease. RESULTS During the 3-year study, complete correction of anemia did not affect the likelihood of a first cardiovascular event (58 events in group 1 vs. 47 events in group 2; hazard ratio, 0.78; 95% confidence interval, 0.53 to 1.14; P = 0.20). Left ventricular mass index remained stable in both groups. The mean estimated GFR was 24.9 ml per minute in group 1 and 24.2 ml per minute in group 2 at baseline and decreased by 3.6 and 3.1 ml per minute per year, respectively (P = 0.40). Dialysis was required in more patients in group 1 than in group 2 (127 vs. 111, P = 0.03). General health and physical function improved significantly (P = 0.003 and P<0.001, respectively, in group 1, as compared with group 2). There was no significant difference in the combined incidence of adverse events between the two groups, but hypertensive episodes and headaches were more prevalent in group 1. CONCLUSIONS In patients with chronic kidney disease, early complete correction of anemia does not reduce the risk of cardiovascular events. (ClinicalTrials.gov number, NCT00321919.)read more
Citations
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Journal ArticleDOI
Epoetin zeta in the management of anemia associated with chronic kidney disease, differential pharmacology and clinical utility.
TL;DR: This review article focuses on epoetin zeta indications in chronic kidney disease, its use in managing anemia of renal origin, and its pharmacology and clinical utility.
Journal ArticleDOI
Iron deficiency in non-dialysis chronic kidney disease
Steven Fishbane,Ajay K. Singh +1 more
TL;DR: The patient had been having excessively heavy menstrual flows, which she noted had been present for many months, and was advised to see a gynecologist, and a diagnosis of excessive menstrual blood loss due to uterine leiomyomas (fibroids).
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Impact of Recent Clinical Trials on Nephrology Practice: Are We in a Stagnant Era?
Maria Yaseen,Waleed M. Hassan,Radwa Awad,Bilal Ashqar,Javier A. Neyra,Tagalie Heister,Omar Malik,Amr El-Husseini +7 more
TL;DR: The slow progress in nephrology research that has impacted clinical practice over the last couple of decades is discussed and the major obstacles, challenges, and potential solutions are highlighted.
Journal ArticleDOI
Value of N-terminal brain natriuretic peptide as a prognostic marker in patients with CKD: results from the CREATE study
Francesco Locatelli,Kai-Uwe Eckardt,Iain C. Macdougall,Dimitrios Tsakiris,Naomi Clyne,Hans-Ulrich Burger,Armin Scherhag,Tilman B. Drüeke,coordinators +8 more
TL;DR: In chronic kidney disease patients with mild-to-moderate anaemia, elevated baseline plasma NT-proBNP levels are associated with a higher risk of cardiovascular events and an accelerated progression towards end-stage renal disease.
Journal ArticleDOI
Simultaneous management of disordered phosphate and iron homeostasis to correct fibroblast growth factor 23 and associated outcomes in chronic kidney disease.
TL;DR: Novel clinical and preclinical studies highlight the effects of phosphate restriction and iron repletion on FGF23 regulation and their benefits and risks in the context of CKD.
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Journal ArticleDOI
Correction of Anemia with Epoetin Alfa in Chronic Kidney Disease
Ajay K. Singh,Lynda A. Szczech,Kezhen L. Tang,Huiman X. Barnhart,Shelly Sapp,Marsha Wolfson,Donal N. Reddan,Abstr Act +7 more
TL;DR: The use of a target hemoglobin level of 13.5 g per deciliter (as compared with 11.3 g perDeciliter) was associated with increased risk and no incremental improvement in the quality of life and the use of epoetin alfa targeted to achieve a level of 11.4 g perdeciliter was not associated with an increased risk.
Journal ArticleDOI
The effects of normal as compared with low hematocrit values in patients with cardiac disease who are receiving hemodialysis and epoetin.
Anatole Besarab,W K Bolton,J K Browne,Joan C. Egrie,Allen R. Nissenson,D M Okamoto,Steve J. Schwab,David A. Goodkin +7 more
TL;DR: In patients with clinically evident congestive heart failure or ischemic heart disease who are receiving hemodialysis, administration of epoetin to raise their hematocrit to 42 percent is not recommended.
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